Winter of discontent.

[oowee]

On 10/12/2022 at 17:07, Dougy said:

Very limited service on the 24th anyway, and 27th is very very low in passengers numbers 25,26th no service so wont have much impact but it will give them a better break over the festive season. 

No doubt the trains will all be in the wrong places so will take a few days to get them sorted and then.... another strike.

I can't get my head around why our train service is so poor and the cost so high. I don't believe its all the fault of the unions. It's often cheaper to fly that just can't be right.

[Newbie to this]

1 hour ago, oowee said:

I can't get my head around why our train service is so poor and the cost so high. I don't believe its all the fault of the unions. It's often cheaper to fly that just can't be right.

I can shed some light on this.

Our trains are mostly operated by other countries natioanlised operators, we pay inflated fares, all with very little reinvestment, that are subsidising their cheap fares.

Edited December 13, 2022 by Newbie to this

[ph5172]

21 hours ago, 7daysinaweek said:

Occasionally I will write an over the counter (OTC) medicines on prescription for such cases when the otc product licence does not allow for it to be purchased otc for certain groups of patients. For example, a child under the age of twelve months may benefit from piriton syrup for treating a allergic urticarial rash, however the product specification licence does not allow it to be dispensed otc for use in infants under the age of twelve months. This would require a prescrition for this.

Patients and parents may find otc medicines helpful at times for treating some minor ailments such as the above which can only be obtained via a prescrition due to the use outside of the product specification at the prescribers discretion. 

I will also occassionally issue a otc medicine prescrition, say for example several children who have scabies in the same household.  Weighing up the probability decision of the parent/s going and paying forty odd quid to treat all the children, thus reducing the risk of a personal financial barrier and the children being treated with a appropriate medicine than the descison of the parent not to buy the treatment otc. If the children are not treated they run a higher risk of complications from the scabies infection. If the parents require treatment I will in most circumstances inform them that they can purchase the preparation over the counter. 

The descision which results in writing an otc prescription is made on a individual basis and thankfully it is not very often. Wherever possible writing a prescition generically which also allows easier access to the medicine and also reduces the overall cost.

As in most cases, OTC medicines are what they are meant for, treating a range of minor self limiting ailments and injuries that the individual can follow the simple self use steps or in addition with simple advice from a pharmacist. On the whole they should not be dispensed on prescrition as they are readily to patients, parents and carers without a prescrition for a smaller cost to the individual. 

On a daily basis I am asked by patients who are both exempt and non exempt from paying prescription charges to write prescriptions for otc medicines. As I have said above in most cases I kindly inform them that the otc medicine that I have suggseted they use for their minor ailment can be readliy obtained buying over the counter without a prescrition. 

Interistingly the second most requested medicine I am asked to write prescritions for is paracetamol, the first being antibiotics.

A very good and sensible approach.
 

I have seen people waiting in A&E for a nurse to come out and dispense half a syringe of calpol. I kid you not. 
 

I cannot get my head around waiting an hour after being seen just to do that. 
I also struggle to comprehend people that decide it’s a good idea to go into A&E on a Saturday night with a week long niggle or rash, a classic was the other week - I can’t stop going to the toilet. In the time between booking in and seeing triage they drank a 2L bottle of coke and a 1 l bottle of water. 
 

[Newbie to this]

45 minutes ago, ph5172 said:

I can’t stop going to the toilet. In the time between booking in and seeing triage they drank a 2L bottle of coke and a 1 l bottle of water. 

Yep, that'll do it

[7daysinaweek]

6 hours ago, ph5172 said:

A very good and sensible approach.
 

I have seen people waiting in A&E for a nurse to come out and dispense half a syringe of calpol. I kid you not. 
 

I cannot get my head around waiting an hour after being seen just to do that. 
I also struggle to comprehend people that decide it’s a good idea to go into A&E on a Saturday night with a week long niggle or rash, a classic was the other week - I can’t stop going to the toilet. In the time between booking in and seeing triage they drank a 2L bottle of coke and a 1 l bottle of water. 
 

Cheers ph, a stepwise approach to completing a minor episode of care.

That would be some bladder that! 😓

 

Increasingly over the last twenty years or so, society has developed a culture in which most individuals cannot make even the most basic decisions for there own minor health needs. On a daily basis I see patients who book in without even attempting to take any very simple self help measures or otc medicine/pharmacy advice. Such things as a dry cough that has developed within the last few hours or 24 hours or so with no associated chest pain, shortness of breath or prexisting conditions and otherwise well. Saw a fingernail a few weeks ago that had been cut with a nail clipper just a little close to the nail bed. Arrgghhh!

These are just a couple of the minor presentations people book in with in between the suspected heart attacks, strokes, septic babies, the babies children and adults exacerbationg in life threatening respiratory distress among everything else and then complain that the very unwell people are being seen before them.

Attendance just booking into AED with minor ailment, minimal treatment and discharge with no admission required, cost £250

Gp 10 minute consulation £45

Walk in centre/Urgent care centre visit £75

District nurse home visit £75

Them costs soon stack up for the old nhs.

 

 

[Rem260]

12 hours ago, 7daysinaweek said:

Cheers ph, a stepwise approach to completing a minor episode of care.

That would be some bladder that! 😓

 

Increasingly over the last twenty years or so, society has developed a culture in which most individuals cannot make even the most basic decisions for there own minor health needs. On a daily basis I see patients who book in without even attempting to take any very simple self help measures or otc medicine/pharmacy advice. Such things as a dry cough that has developed within the last few hours or 24 hours or so with no associated chest pain, shortness of breath or prexisting conditions and otherwise well. Saw a fingernail a few weeks ago that had been cut with a nail clipper just a little close to the nail bed. Arrgghhh!

These are just a couple of the minor presentations people book in with in between the suspected heart attacks, strokes, septic babies, the babies children and adults exacerbationg in life threatening respiratory distress among everything else and then complain that the very unwell people are being seen before them.

Attendance just booking into AED with minor ailment, minimal treatment and discharge with no admission required, cost £250

Gp 10 minute consulation £45

Walk in centre/Urgent care centre visit £75

District nurse home visit £75

Them costs soon stack up for the old nhs.

 

 

Perhaps if you sent them away with no prescription and a flea in their ear for wasting your time.  Then the message would soon get out.

Edited December 15, 2022 by Rem260

[Mice!]

13 hours ago, 7daysinaweek said:

Cheers ph, a stepwise approach to completing a minor episode of care.

That would be some bladder that! 😓

 

Increasingly over the last twenty years or so, society has developed a culture in which most individuals cannot make even the most basic decisions for there own minor health needs. On a daily basis I see patients who book in without even attempting to take any very simple self help measures or otc medicine/pharmacy advice. Such things as a dry cough that has developed within the last few hours or 24 hours or so with no associated chest pain, shortness of breath or prexisting conditions and otherwise well. Saw a fingernail a few weeks ago that had been cut with a nail clipper just a little close to the nail bed. Arrgghhh!

These are just a couple of the minor presentations people book in with in between the suspected heart attacks, strokes, septic babies, the babies children and adults exacerbationg in life threatening respiratory distress among everything else and then complain that the very unwell people are being seen before them.

Attendance just booking into AED with minor ailment, minimal treatment and discharge with no admission required, cost £250

Gp 10 minute consulation £45

Walk in centre/Urgent care centre visit £75

District nurse home visit £75

Them costs soon stack up for the old nhs.

 

 

I'll never understand why those with nothing really wrong with them can be bothered to go and sit at A+E wait around hours.

They walk among us 😡

[amateur]

Just now, Mice! said:

I'll never understand why those with nothing really wrong with them can be bothered to go and sit at A+E wait around hours.

They walk among us 😡

It's warm, there is access to food and drink and it's not as if they have jobs to go to

[Bigbob]

1 hour ago, Mice! said:

I'll never understand why those with nothing really wrong with them can be bothered to go and sit at A+E wait around hours.

They walk among us 😡

We used to get that with the students any medical call to security even if we treated them you had to offer a free taxi ride to hospital , I always said its a waste of time you will be sitting there most of the night but if you wish to go i can get you there and offer a free taxi back when your ready .Some but mostly the foreigner's who couldn't believe they would get free treatment alway took you up on it  , A follow up visit the next day said i wish i listened to you 5 hours sitting in a department full of drunks LOL 

[7daysinaweek]

7 hours ago, Rem260 said:

Perhaps if you sent them away with no prescription and a flea in their ear for wasting your time.  Then the message would soon get out.

I wish that was the case Rem but for many it is not.

Over the years I have been taken to account by the management for highlighting to the patient an inappropriate attendance. Have had patients take umbrage to this and formalise a complaint, though the complaints have had no real basis for even a concern, nor any lack of 'duty of care', once formalised they have to go through the duty of candour process and the patient has to be informed of the outcome of the formalised complaint. (Mangers don't like complaints)

I now fully quote document when I tell individuals that attending was not really needed and that the minor ailment could be more appropriately managed by self care or having spoken with a community pharmacist. This is in part in hope of empowering some with the aim of improving behaviour in realtion to the best use of health services in the future.

I write thousands of prescriptions a year for all manner of drugs, however if there is no clinical justification for issuing one, I will not. Writing prescriptions for all and sundry only serves to validate patients concerns and expectations without a clinical rationale. This can lead to increasing microbial resistance for all, increases dependency on certain medicines and ultimately increases the cost for the taxpayer and further service burdens.

In work, rarely a day does not pass that I am not subjected to aggression and on rarer occasions violence just because I have not issued a prescription for say antibitics or pain relief among other medications that have not cleary been indicated in their case.

For some individuals I see them walk through the doors week in, week out and they will foreseeably continue to use innaproriate services without heeding our advice in relation to minor presentations.

Hardest thing trying to change peoples behaviours.

Frustrating for all involved at the end of the day.

atb

7diaw

5 hours ago, Mice! said:

I'll never understand why those with nothing really wrong with them can be bothered to go and sit at A+E wait around hours.

They walk among us 😡

Droves more people attend now than ever before, mental health issues/general anxiety disorders, more illicit drug use than ever which modifies behaviours and manifests negative behaviurs in relation to self management of even the most minor/simplist of non evident physiological or psychological ailments which are subclinical. (unable to be detected) For some it may serve  to self validate an illness irrespective of clinical evidence of one that is then shared within their social media circle as a form of acceptance. We get groups coming in at times of up to three and four people with only one of them booking in all validating for the single person, the others are asked to leave, sometimes one person may accompany them at the patients request and discretion of triage and infection control protocols. Lots of parts of societal culture have issues that ultimately impact health services increasingly. 

They certainly do K!

By the way mate I will definately get over and see you in the early new year, bring you some goodies over. No used gloves or blunt needles I promise! 

atb over the festive period and hope the kids have a great one, which no doubt they will.

 

Edited December 15, 2022 by 7daysinaweek

[Mice!]

3 hours ago, 7daysinaweek said:

They certainly do K!

By the way mate I will definately get over and see you in the early new year, bring you some goodies over. No used gloves or blunt needles I promise! 

atb over the festive period and hope the kids have a great one, which no doubt they will.

Kettles always ready mate 👍

Don't know how you manage knowing your having your time wasted, I've no doubt you've gotten used to it over the years but it must boil your .....

I have to be bleeding badly or broken to want to go to a hospital,  certainly strange times.

[Vince Green]

Combining two different threads with this one. In Newquay there is a hotel which has been taken over for the migrants 

Locals report seeing ambulances there all the time. The reason being apparently that every time one of the migrants gets a runny nose or a bit of a temperature the wardens running the place call for an ambulance. 

It's buck passing, their duty of care means they have to be seen to be doing something in case it does turn out to be something more serious.

It must be costing the NHS a fortune

[discobob]

8 hours ago, Vince Green said:

It's buck passing, their duty of care means they have to be seen to be doing something in case it does turn out to be something more serious.

It must be costing the NHS a fortune

I have seen figures as high as 7million a day for the migrants - and I think that is a gross misunderstatement - factoring everything in it must be 10-15million if not more

[Newbie to this]

1 minute ago, discobob said:

I have seen figures as high as 7million a day for the migrants - and I think that is a gross misunderstatement - factoring everything in it must be 10-15million if not more

I'd say way more.

[Vince Green]

6 minutes ago, Newbie to this said:

I'd say way more.

Especially when you factor in the cost of all the criminal activity which nobody seems to want to talk about.

It's like " shush you are not allowed to mention that........"

[Rem260]

16 hours ago, 7daysinaweek said:

I wish that was the case Rem but for many it is not.

Over the years I have been taken to account by the management for highlighting to the patient an inappropriate attendance. Have had patients take umbrage to this and formalise a complaint, though the complaints have had no real basis for even a concern, nor any lack of 'duty of care', once formalised they have to go through the duty of candour process and the patient has to be informed of the outcome of the formalised complaint. (Mangers don't like complaints)

I now fully quote document when I tell individuals that attending was not really needed and that the minor ailment could be more appropriately managed by self care or having spoken with a community pharmacist. This is in part in hope of empowering some with the aim of improving behaviour in realtion to the best use of health services in the future.

I write thousands of prescriptions a year for all manner of drugs, however if there is no clinical justification for issuing one, I will not. Writing prescriptions for all and sundry only serves to validate patients concerns and expectations without a clinical rationale. This can lead to increasing microbial resistance for all, increases dependency on certain medicines and ultimately increases the cost for the taxpayer and further service burdens.

In work, rarely a day does not pass that I am not subjected to aggression and on rarer occasions violence just because I have not issued a prescription for say antibitics or pain relief among other medications that have not cleary been indicated in their case.

For some individuals I see them walk through the doors week in, week out and they will foreseeably continue to use innaproriate services without heeding our advice in relation to minor presentations.

Hardest thing trying to change peoples behaviours.

Frustrating for all involved at the end of the day.

atb

7diaw

Droves more people attend now than ever before, mental health issues/general anxiety disorders, more illicit drug use than ever which modifies behaviours and manifests negative behaviurs in relation to self management of even the most minor/simplist of non evident physiological or psychological ailments which are subclinical. (unable to be detected) For some it may serve  to self validate an illness irrespective of clinical evidence of one that is then shared within their social media circle as a form of acceptance. We get groups coming in at times of up to three and four people with only one of them booking in all validating for the single person, the others are asked to leave, sometimes one person may accompany them at the patients request and discretion of triage and infection control protocols. Lots of parts of societal culture have issues that ultimately impact health services increasingly. 

They certainly do K!

By the way mate I will definately get over and see you in the early new year, bring you some goodies over. No used gloves or blunt needles I promise! 

atb over the festive period and hope the kids have a great one, which no doubt they will.

 

Unfortunately I bet many of your colleagues keep the peace and just go along with the attendees request. I don't call them patients as that would indicate they have genuine reasons for attendance. If more people were to stand up like you, tell people the truth and then have the backing of the management.  I doubt we wouldn't be in the mess we are. I can also see that the threat of violence may have a factor in appeasing people.

I am sure there could be huge savings and benefits to the system if management came on side. 

Keep up the good work and stay safe.

[7daysinaweek]

8 hours ago, Rem260 said:

Unfortunately I bet many of your colleagues keep the peace and just go along with the attendees request. I don't call them patients as that would indicate they have genuine reasons for attendance. If more people were to stand up like you, tell people the truth and then have the backing of the management.  I doubt we wouldn't be in the mess we are. I can also see that the threat of violence may have a factor in appeasing people.

I am sure there could be huge savings and benefits to the system if management came on side. 

Keep up the good work and stay safe.

Thank you Rem 👍

[12gauge82]

On 15/12/2022 at 18:45, 7daysinaweek said:

I wish that was the case Rem but for many it is not.

Over the years I have been taken to account by the management for highlighting to the patient an inappropriate attendance. Have had patients take umbrage to this and formalise a complaint, though the complaints have had no real basis for even a concern, nor any lack of 'duty of care', once formalised they have to go through the duty of candour process and the patient has to be informed of the outcome of the formalised complaint. (Mangers don't like complaints)

I now fully quote document when I tell individuals that attending was not really needed and that the minor ailment could be more appropriately managed by self care or having spoken with a community pharmacist. This is in part in hope of empowering some with the aim of improving behaviour in realtion to the best use of health services in the future.

I write thousands of prescriptions a year for all manner of drugs, however if there is no clinical justification for issuing one, I will not. Writing prescriptions for all and sundry only serves to validate patients concerns and expectations without a clinical rationale. This can lead to increasing microbial resistance for all, increases dependency on certain medicines and ultimately increases the cost for the taxpayer and further service burdens.

In work, rarely a day does not pass that I am not subjected to aggression and on rarer occasions violence just because I have not issued a prescription for say antibitics or pain relief among other medications that have not cleary been indicated in their case.

For some individuals I see them walk through the doors week in, week out and they will foreseeably continue to use innaproriate services without heeding our advice in relation to minor presentations.

Hardest thing trying to change peoples behaviours.

Frustrating for all involved at the end of the day.

atb

7diaw

Droves more people attend now than ever before, mental health issues/general anxiety disorders, more illicit drug use than ever which modifies behaviours and manifests negative behaviurs in relation to self management of even the most minor/simplist of non evident physiological or psychological ailments which are subclinical. (unable to be detected) For some it may serve  to self validate an illness irrespective of clinical evidence of one that is then shared within their social media circle as a form of acceptance. We get groups coming in at times of up to three and four people with only one of them booking in all validating for the single person, the others are asked to leave, sometimes one person may accompany them at the patients request and discretion of triage and infection control protocols. Lots of parts of societal culture have issues that ultimately impact health services increasingly. 

They certainly do K!

By the way mate I will definately get over and see you in the early new year, bring you some goodies over. No used gloves or blunt needles I promise! 

atb over the festive period and hope the kids have a great one, which no doubt they will.

 

I know I shouldn't be, but I'm in virtual disbelief over some of what you've written.

I can't get my head around why anybody would want to waste their own, but more importantly, other people's time and money.

The fact that groups of them come in blows my mind. I'm trying to imagine how a conversation with my group of friends would go if I were to attempt to persuade them to attend an appointment for some nonsensical reason, I can only imagine it would start with f and end in off, and rightly so! 

[Vince Green]

On 14/12/2022 at 15:53, ph5172 said:

A very good and sensible approach.
 

I have seen people waiting in A&E for a nurse to come out and dispense half a syringe of calpol. I kid you not. 
 

I cannot get my head around waiting an hour after being seen just to do that. 
I also struggle to comprehend people that decide it’s a good idea to go into A&E on a Saturday night with a week long niggle or rash, a classic was the other week - I can’t stop going to the toilet. In the time between booking in and seeing triage they drank a 2L bottle of coke and a 1 l bottle of water. 
 

My mother's Hungarian carer would go to A&E for a sore throat or period pains  She was happy to wait to be seen because (I believe) she came from somewhere where healthcare wasn't bottomless and free.

If its there you would be silly not to take advantage of it. I think there are a lot of people in this country who come from parts of the world where even the most basic health care is beyond their means

[Newbie to this]

40 minutes ago, Vince Green said:

My mother's Hungarian carer would go to A&E for a sore throat or period pains  She was happy to wait to be seen because (I believe) she came from somewhere where healthcare wasn't bottomless and free.

If its there you would be silly not to take advantage of it. I think there are a lot of people in this country who come from parts of the world where even the most basic health care is beyond their means

It's one of, if not the biggest draws for people wanting to come to the UK.

A draw which costs the tax payer a fortune, because the NHS refuse to do their job and charge.

[Vince Green]

43 minutes ago, Newbie to this said:

It's one of, if not the biggest draws for people wanting to come to the UK.

A draw which costs the tax payer a fortune, because the NHS refuse to do their job and charge.

You are absolutely right because even in Europe health care is not free. People who have grown up with it in this country take it for granted but they have never lived in countries where its not free.

[Nuke]

On 09/12/2022 at 10:27, derbyduck said:

oh and how much have you paid ? and your suggestion is what ? nuke the old folks homes ,the Darby & Joan clubs ,or perhaps the Final Solution Mien Herr 

Like you to little.

/Markus 

[old man]

On 19/12/2022 at 17:27, Newbie to this said:

It's one of, if not the biggest draws for people wanting to come to the UK.

A draw which costs the tax payer a fortune, because the NHS refuse to do their job and charge.

Just the way it seems here now, ignore the rules where things are a bit difficult?

 

[derbyduck]

3 hours ago, Nuke said:

Like you to little.

/Markus 

yes perhaps so, but we have both paid more than the dross of eastern Europe and northern Africa that are landing on our shores each day! it is they that will break our way of life ! add the corrupt self serving politicians to the brew , 

don't worry to much about the OAPs they will be thinned out due to fuel rises and the closure of hospitals !

                                    Merry Christmas .

[old man]

And the current crop of viruses?